There are many insurance companies running ads talking about those extra benefits they are offering. This type of coverage depends on the Medicare coverage you have.
In most situations, Original Medicare does not cover the cost of hearing aids, glasses and dental work. Original Medicare is a health insurance product, which means that all of your coverage must be based on a medical problem or diagnoses.
To begin, Medicare covers the cost of an audiological evaluation, including tests of tinnitus (perception of noise in the ear and head), auditory processing and osseointegrated devices. The Auditory Osseointegrated devices (cochlear implant) are appropriate for patients with ear malformations and when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe hearing loss or surgery. This situation is rare.
Hearing aids are considered ‘Audiological Treatment’, and not covered by Original Medicare. If you have a disorder of the auditory systems, however, you have coverage for speech-language pathology services.
When you have Medicare and have enrolled into a Medicare Advantage (MA) plan, HMO, PPO, or PFFS plan, you may have limited coverage of the hearing aids. For example, some plans give you an allotment for your hearing aid, some pay a specific dollar amount, and some pay up to 50% at the appropriate vendor. With a MA plan, be sure to call the plan prior to making your appointment, so you use their preferred vendor and avoid the most out of pocket expense.
Employee/retiree plans can cover hearing aids on occasion, but this is generally an item that you will have to pay for yourself.
When shopping for hearing aids, you are not comparing apples to apples; each type of hearing aid device has different strengths and weaknesses. Just because a hearing aid is expensive doesn’t mean it is the best for you. Just because it is small doesn’t mean it will be useful. I would recommend seeing an Audiologist who will be able to diagnose the type of hearing issues you have and recommend the best type for your situation.
When it comes to eye care, Medicare will cover issues including but not limited to glaucoma, cataracts, injuries, infections or macular degeneration.
After cataract surgery, your vision may change and you may not need glasses. If you still need corrective lenses after your surgery, Medicare will pay for the lens on the eye that had surgery and/or a standard frame. Remember that this benefit is paid under Medicare Part B, so the usual deductible and co-pays apply.
Many MA plans, (HMO, PPO, and PFFS plan) give you additional coverage for glasses, such an allotment, or a specific dollar amount. This will not pay for the glasses, but it will help to offset your cost. With a MA plan, be sure to call the plan prior to getting your glasses to stay within the Provider Network and to be sure what type of glasses/frame are covered.
Some employee/retiree plans that cover glasses, be sure to contact your insurance provider and ask what is covered and how it is covered. In some situations you can get safety glasses with corrective lenses, glasses for general use or other types.
Lastly regarding dental coverage, this is something that Original Medicare rarely covers. Dental Coverage is a relatively new added and highly advertised benefit for MA Plans. This should be looked at carefully. Most plans state they cover dental, but they may define that coverage as two (2) free cleanings and one (1) bite wing x-ray a year. This may be less coverage than you expect or need. Dental coverage should be researched thoroughly before selecting a plan.
It is important to remember that Medicare Advantage (MA) plans must give you at least the minimum that Medicare gives you, but they can give you more coverage.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.